Member Complaints Coordinator

Job Summary

Tracking and managing member complaints and grievances, the full-time Member Complaints Coordinator will ensure effective resolution and utilize data analysis to identify improvement opportunities while working remotely during daylight hours.

Key responsibilities:

• Investigate and respond to member complaints, grievances, and provider appeals in accordance with department standards
• Collaborate with internal and external contacts to facilitate the resolution process and ensure compliance with regulatory guidelines
• Organize tasks within regulatory deadlines and assist in reporting complaint and grievance data to relevant bodies

Required qualifications:

• Associate degree or equivalent professional work experience
• 1 year of experience in a healthcare environment
• Preferred background in medical claims and/or customer service
• Understanding of managed care principles and experience in problem-solving and decision-making
• Familiarity with ICD-10, HCPCS, and CPT4 coding and medical terminology